We’ll be adding Evenity to the Medicare Part B medical drug prior authorization list

We’re adding Evenity^® (J3111) to the Medicare Plus Blue^SM PPO and BCN Advantage^SM Part B medical drug prior authorization list for dates of service on or after Nov.1, 2019. 

Medicare Plus Blue PPO
For Medicare Plus Blue, we’ll require prior authorization for this medication for the following sites of care when you bill the medication electronically through an 837P transaction or on a professional CMS-1500 claim form:

• Physician office (place of service code 11)
• Outpatient facility (place of service code 19, 22 or 24)

BCN Advantage
For BCN Advantage, we’ll require prior authorization for this medication for the following sites of care when you bill the medication as a professional service or as an outpatient facility service, and when you bill electronically through an 837P transaction or on a professional CMS-1500 claim form:

• Physician office (place of service code 11)
• Outpatient facility (place of service code 19, 22 or 24)
• Home (place of service code 12)

We’ll also require prior authorization when you bill electronically through an 837I transaction or use a UB04 claim form for a hospital outpatient type of bill 013x.

Use NovoLogix to submit requests
The NovoLogix^® online tool offers real-time status checks and immediate approvals for certain medications.

To gain access:

• For BCN Advantage, access to Provider Secured Services gives you automatic access to NovoLogix. There’s nothing more you need to do.
• For Medicare Plus Blue, if you have a Type 1 (individual) NPI and you checked the “Medical Drug PA” box when you completed the Provider Secured Services Application, you have access to NovoLogix. If you didn’t check that box, complete Addendum P and fax it to the number on the form.

If you need access to Provider Secured Services, complete the Provider Secured Services Application and fax it to the number on the form.

To access NovoLogix through Provider Secured Services:

1. Visit bcbsm.com/providers.
2. Click Login.
3. Log in to Provider Secured Services.
4. Click one of the following on the Provider Secured Services homepage.
   • BCN Medical Benefit – Medication Prior Authorization
   • Medicare Advantage PPO Medical Benefit – Medication Prior Authorization
5. Enter or select your NPI and click Go.

If you can’t log in to Provider Secured Services, call 1-877-258-3932 from 8 a.m. to 8 p.m. Eastern time Monday through Friday.

If you have questions about authorizations, call the Pharmacy Help Desk at 1‑800‑437‑3803 from 9 a.m. to 4 p.m. Eastern time Monday through Friday.